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CHART NO. <br /> 1 <br /> ��.c',� �4�•^F��.��� <br /> Sewer Application and Permit <br /> ?.3031 p�� _ t/1//93 <br /> Service AOOress �615 P�cific f{�f Utpity AorouM No. <br /> Billirq Address � `�oz 810 <br /> Cm�$Iffi0�ZIP i� L�[t VA 94206 Permit Fee s 10.00 , _ <br /> p�.��� y� c._ — ConnectionCharge <br /> Cornectbn by Trunk E <br /> Address Leteral E <br /> TMeI Connectbn Cha�pe S <br /> Phone Utility Development Fee - <br /> -'Legal Deecription: Water S <br /> Lot Sewer S <br /> Block Total Oevelopment Fee E <br /> Plat <br /> Unpiatled Descrlptlon: Sewer Bond District - <br /> Abuttirp Wl Line <br /> N,5,E,W � � <br /> Type o1 Pertnfl �P-Oft Approved By <br /> Remarks Isaued By GB <br /> cuetortrorspnatuie—i�.---- �*''''– <br /> IMPORTANTI �"�e � <br /> CALL 1-800-424-5555 48-HOURS � ���`� ` <br /> �.a. i� <br /> PRIOR TO DIGGING � „ c <br /> M IJ <br /> CALL 259�8810 FOR INSPECTION ���a By� <br /> � �� Date Inspected � <br /> �,��J� �� �, 3� <br /> S ,w/.tr �, r D� � <br /> SEE SKETCM ATfACNED L� �/9 3 <br /> INSPECTION � , �° Z 9�3� <br /> � <br />